Is infertility common in Polycystic Kidney Disease (PKD)?

Infertility in Polycystic Kidney Disease

Infertility is not common in polycystic kidney disease (PKD), though men with ADPKD may experience reproductive issues due to seminal tract abnormalities that do not typically impact overall fertility. 1

Male Fertility in ADPKD

Prevalence of Reproductive Tract Abnormalities

• Men with ADPKD show increased prevalence of seminal tract cysts and sperm abnormalities 1
• Seminal vesicle cysts are common, occurring in 20-40% of men with ADPKD 1
• Seminal vesicle ectasia (>10mm) occurs in approximately 23% of men 1

Impact on Fertility

• Despite these anatomical abnormalities, no large study has demonstrated that male infertility is more common in ADPKD 1
• According to the 2025 KDIGO guidelines, seminal vesicle cysts and ectasia, although commonly identified, do not result in male infertility 1

Case Reports of Male Infertility

While the guidelines indicate fertility is generally preserved, some case reports describe:

• Secondary infertility due to necrospermia in men with ADPKD 2
• Progressive deterioration of semen quality over time in some men 2
• Obstructive azoospermia due to compression from dilated seminal vesicle cysts 3

Female Fertility in ADPKD

• Women with ADPKD generally do not have direct fertility problems 2, 4
• A study of 137 women at risk of ADPKD found no difference in fertility rates between those with and without the disease 4
• The prevalence of spontaneous abortion and stillbirth was not different between women with ADPKD and controls 4

Pregnancy Considerations in ADPKD

While fertility is generally preserved, women with ADPKD should be aware of:

• Increased risk of hypertension during pregnancy 4
• Higher frequency of preeclampsia 1
• Increased risk of preterm birth 1
• Need for monitoring by a multidisciplinary team during pregnancy 1

Reproductive Options and Counseling

• Preconception counseling should be offered to both men and women with ADPKD 1
• Counseling should include discussion of the 50% risk of transmitting ADPKD to offspring 1
• Options to prevent disease transmission include:
  • Preimplantation genetic testing
  • Prenatal testing
  • Sperm donation (for affected males)
  • Accepting the 50% risk of transmission 1

Treatment Options for Infertility Cases

For the minority of men who do experience infertility:

• Intracytoplasmic sperm injection (ICSI) has been used successfully in men with ADPKD-related infertility 5
• However, ICSI success rates may be lower in ADPKD patients compared to those with other causes of infertility 5

Key Takeaways

• Infertility is not a common manifestation of ADPKD in either men or women
• Men with ADPKD commonly have seminal tract cysts but these typically don't affect fertility
• Women with ADPKD have normal fertility but face increased pregnancy complications
• In rare cases where infertility occurs, assisted reproductive technologies can be considered
• Genetic counseling is important for family planning in all patients with ADPKD